1. Technical Field
The present disclosure relates generally to the field of endoscopic surgical devices and, more particularly, to an instrument kit and method for performing a meniscal repair procedure.
2. Background of Related Art
Intracorporeal tearing of body tissue occurs most often at bone joint regions. Certain body tissues act as a cushion for absorbing the forces of joint movement, preventing friction in the joint and channeling the mechanical stress and strain associated with such movement. Like any shock-absorbing material, such body tissues experience failure when applied forces exceed the strength of the material, including failure as a result of shear and tension forces.
Human joints include a type of shock-absorbing body tissue known as a “meniscus” made up of a fibrous cartilage. For example, each human knee includes two generally crescent-shaped menisci residing on the tibial plateau, commonly known in the medical community as the medial meniscus and the lateral meniscus. The peripheral rim of the meniscus is thick, tapering down to a thin free inner border. The superior surface is concave in order to contact the femoral condyles, while the inferior surface is planar to contact the tibial plateau. It is generally recognized that repair of meniscal lesions and/or tears, to the extent possible, is preferable to excision so as to attempt to maintain the normality of the meniscus and have it continue to function properly.
Untreated meniscal tears may result in ultimate deterioration of the meniscus as well as other complications. Generally, repair of a meniscal tear is accomplished by holding the sides of the tear together, usually for at least six weeks, to allow the body to regenerate. Accordingly, several different techniques have been developed for repairing meniscal tears.
Many of the presently known techniques for repairing meniscal tears in the knee have proven to be a significant benefit in the relief of knee injuries, pain and discomfort. Four major techniques are known in the field of meniscal repair, namely, “open” technique, “inside-out” technique, “outside-in” technique and “all inside” technique. Each of these techniques generally involves the suturing of the sides of the meniscal tear together.
One known technique for repairing torn meniscus tissue involves the use of a pair of surgical needles which are inserted through cannuli into the knee on opposite sides of the meniscal tear. The ends of the needles include a length of suture material which is pushed down through the cannuli and across the tear. An incision is made in the skin at the point where the needle exits the knee joint so that the leading end of each needle may be grasped and pulled through the joint. The ends of the suture are then grasped after the needles are removed from the suture ends and the suture is then tied so that a horizontal suture is created in the meniscus. This procedure is repeated for placement of as many sutures as necessary to repair the meniscal tear. As is apparent, this procedure is both time consuming and difficult to effect.
Another procedure is outlined in U.S. Pat. No. 5,002,562. Briefly, in this procedure, a barbed clip and an instrument for applying the clip are utilized. The instrument includes a pair of opposed arcuate jaws which are shaped to hold a complementary shaped curved surgical clip therebetween. The barbs of the clip are retained within notches in the jaws until the clip is inserted. The legs of the clip are joined by a flexible suture material. The jaws are biased in a normally open position, and as the jaws are pushed into the tissue, the jaws are closed to overlap thereby moving the legs of the clip together. The jaws are then reopened and backed out of the tissue leaving the clip in position in the tissue.
Another technique and apparatus for meniscal repair is illustrated in U.S. Pat. No. 5,997,552. The '552 patent details a meniscal fastener applying device which applies fasteners sequentially from a longitudinally extending magazine. An advancing mechanism is operatively associated with an elongated body portion of the device for sequentially advancing surgical fasteners from a fastener supply to a firing position in alignment with a firing mechanism. The fastener includes a pair of anchor members whose proximal-most ends are connected by a suture material offset from the central longitudinal axis thereof. Due to the parallel over-under orientation of the firing mechanism and the longitudinally extending fastener magazine, the elongated body portion of the device requires a substantial cross-sectional area and necessarily requires a correspondingly wide distension of the knee joint to access the meniscal tissue to be repaired.
A refinement to the meniscal repair technique is disclosed in commonly assigned co-pending U.S. patent application Ser. No. 09/829,804 (hereinafter “the '804 application), filed Apr. 10, 2001, entitled “Single Shot Meniscal Repair Device”, the entire contents of which are hereby incorporated by reference. This application discloses a repair device which incorporates a minimally sized elongate body portion configured to hold a single fastener adjacent a distal end thereof. The elongate body portion is part of a disposable loading unit (“DLU”) structure which provides a 360° rotational capability about its longitudinal axis. The elongate body portion includes push rods for expelling a fastener. The elongate body portion may be provided with a locating barb at its distal end to assist in the stabilization of the device at the firing point. The repair device may be provided with a plurality of interchangeable DLU's. One of the DLU's may have a distal portion which is angled off axis to enhance the versatility of the device.
When using a mechanical repair device, such as the device disclosed in the '804 application, the need exists for a series of surgical templates which substantially approximate the configuration of the DLU and the path the DLU will follow through the tissue. In this manner, a surgeon can use the series of surgical templates interchangeably in order to select an appropriate DLU which would most effectively deliver the fastener to the surgical site (i.e., the meniscal tear).